Real-Life Nationwide Outcomes of Bronchoscopic Lung Volume Reduction with Endobronchial Valves in Severe Chronic Obstructive Pulmonary Disease.

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally, characterized by airflow limitation and lung hyperinflation due to emphysema. Bronchoscopic lung volume reduction (BLVR) with endobronchial valves offers a minimally invasive treatment option for emphysema, aiming to reduce lung hyperinflation, thereby improving lung function and exercise tolerance.

Methods: This study evaluated the efficacy of BLVR in a real-life nationwide setting using comprehensive Danish registries. The study population included patients who underwent BLVR between January 1, 2013, and December 31, 2021. We assessed clinical outcomes, including forced expiratory volume in 1 s (FEV1), Medical Research Council (MRC) dyspnea score, and the rates of exacerbations and pneumonia before and after the procedure. A control cohort of matched COPD patients was also analyzed.

Results: Following BLVR, a significant increase in FEV1, similar to the improvements reported in randomized controlled trials, was observed. Additionally, the proportion of patients classified as GOLD stage IV decreased from 71.3% to 60.6% after BLVR. The incidence rate ratio for severe exacerbations significantly dropped to 0.56 (95% confidence interval 0.47-0.67, p < 0.01) after BLVR. No significant changes were observed in the rates of moderate and severe pneumonia, and mortality rates did not differ significantly from those in the matched control cohort.

Conclusion: This study demonstrates the real-life efficacy of BLVR using endobronchial valves, highlighting a significant improvement in FEV1 and a reduction in severe COPD exacerbations. The procedure did not increase pneumonia rates or affect mortality, supporting continued use of BLVR for managing patients with COPD.